New Jersey-2024-S1276-Introduced

An Act concerning health insurance coverage of prenatal genetic testing and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the contract.

c. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

d. For the purpose of this section, "carrier screening" means a blood sample or tissue sample swabbed from inside the cheek of an individual to determine whether the individual carries a gene for certain inherited disorders.

2. a. Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the contract.

c. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

3. a. Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the contract.

c. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

4. a. Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S. 17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the policy.

c. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.

5. a. Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the policy.

c. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.

6. a. Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide health care services to any enrollee or other person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.

c. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.

7. a. Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

c. The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.

8. a. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

c. The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.

9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act, that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the contract.

c. For the purpose of this section, "carrier screening" means a blood sample or tissue sample swabbed from inside the cheek of an individual to determine whether the individual carries a gene for certain inherited disorders.

10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits shall be provided shall include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling.

b. The benefits shall be provided to the same extent as for any other medical condition under the contract.

11. This act shall take effect on the 90th day next following enactment and shall apply to policies and contracts that are delivered, issued, executed, or renewed on or after that date.

STATEMENT

This bill requires health insurance coverage of a prenatal genetic test during the first trimester of pregnancy.

Under the bill, health insurance carriers (including insurance companies, hospital service corporations, medical service corporations, health service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, and any entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees' Health Benefits Program) will be required to cover a prenatal genetic test during the first trimester of a pregnancy. The methods of testing for which benefits will be provided will include, but not be limited to, a carrier screening, a nuchal translucency screening, and a chorionic villus sampling. For the purpose of this bill, "carrier screening" means a blood sample or tissue sample swabbed from inside the cheek of an individual to determine whether the individual carries a gene for certain inherited disorders.